| National Provider Identifier [NPI]: |
1184931107 |
| Last Name Of The Provider |
PRINT |
| First Name Of The Provider |
CHERRIE |
| Middle Initial Of The Provider |
|
| Credentials Of The Provider |
AA |
| Gender Of The Provider |
F |
| Entity Type Of The Provider |
I |
| Street Address 1 Of The Provider |
1600 SW ARCHER RD |
| Street Address 2 Of The Provider |
|
| City Of The Provider |
GAINESVILLE |
| Zip Code Of The Provider |
326103003 |
| State Code Of The Provider |
FL |
| Country Code Of The Provider |
US |
| Provider Type Of The Provider |
Anesthesiologist Assistants |
| Medicare Participation Indicator |
Y |
| Number Of HCPCS |
39 |
| Number Of Services |
173 |
| Number Of Medicare Beneficiaries |
168 |
| Total Submitted Charge Amount |
224948.7 |
| Total Medicare Allowed Amount |
19195.47 |
| Total Medicare Payment Amount |
14632.62 |
| Total Medicare Standardized Payment Amount |
14592.69 |
| Drug Suppress Indicator |
|
| Number Of HCPCS Associated With Drug Services |
0 |
| Number Of Drug Services |
0 |
| Number Of Medicare Beneficiaries With Drug Services |
0 |
| Total Drug Submitted ChargeAmount |
0 |
| Total Drug Medicare AllowedAmount |
0 |
| Total Drug Medicare PaymentAmount |
0 |
| Total Drug Medicare Standardized Payment Amount |
0 |
| Medical SuppressIndicator |
|
| Number Of HCPCS Associated With MedicalServices |
39 |
| Number Of Medical Services |
173 |
| Number Of Medicare Beneficiaries With Medical Services |
168 |
| Total Medical Submitted Charge Amount |
224948.7 |
| Total Medical Medicare Allowed Amount |
19195.47 |
| Total Medical Medicare Payment Amount |
14632.62 |
| Total Medical Medicare Standardized Payment Amount |
14592.69 |
| Average Age Of Beneficiaries |
67 |
| Number Of Beneficiaries Age Less65 |
55 |
| Number Of Beneficiaries Age 65 to 74 |
69 |
| Number Of Beneficiaries Age 75 to 84 |
|
| Number Of Beneficiaries Age Greater 84 |
|
| Number Of Female Beneficiaries |
102 |
| Number Of Male Beneficiaries |
66 |
| Number Of Non Hispanic White Beneficiaries |
128 |
| Number Of Black or African American Beneficiaries |
|
| Number Of AsianPacific Islander Beneficiaries |
|
| Number Of Hispanic Beneficiaries |
|
| Number Of American Indian Alaska Native Beneficiaries |
|
| Number Of Beneficiaries With Race Not Else where Classified |
|
| Number Of Beneficiaries With Medicare Only Entitlement |
114 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement |
54 |
| Percent Of With Atrial Fibrillation |
14 |
| Percent Of With Alzheimers Disease or Dementia |
14 |
| Percent Of With Asthma |
10 |
| Percent Of With Cancer |
13 |
| Percent Of With Heart Failure |
23 |
| Percent Of With Chronic Kidney Disease |
41 |
| Percent Of With Chronic Obstructive Pulmonary Disease |
18 |
| Percent Of With Depression |
46 |
| Percent Of With Diabetes |
39 |
| Percent Of With Hyperlipidemia |
64 |
| Percent Of With Hypertension |
75 |
| Percent Of With Ischemic Heart Disease |
43 |
| Percent Of With Osteoporosis |
11 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis |
43 |
| Percent Of With Schizophrenia Other PsychoticDisorders |
13 |
| Percent Of With Stroke |
|
| Average HCC Risk Score Of Beneficiaries |
1.5395 |